Category Archives: The Empowered Patient

In-Network Doctors – Quantity over Quality

Posted on May 16, 2012 | 1 Comment

Last Friday, I went for an annual Ophthalmology “check-up.”  Since my Eyes are not my primary medical concern and I’m broke from all my other medical problems, I decided to “work my health insurance plan” to find a doctor and, in the process, take my own advice.  Mind you, while Crohn’s Disease and my Gut are to me what Kryptonite is to Superman (if you have never heard of “Crohn’s Disease Man” you just aren’t reading enough comic books), my Eyes are nevertheless of vital importance to me.  Moreover, the auto-immune aspects of Crohn’s Disease have been known to affect the Eye so it wasn’t like I was going to see a Podiatrist or a Psychic and could thus roll the dice.  In that regard, I apologize to all the Psychics out there for comparing you to Podiatrists.

Tolerating “Quantity over Quality” from In-Network Doctors

More seriously, I have learned to merely “tolerate” my Insurance IN-Network Doctors based on my present experience with an Endocrinologist who has more satellite offices than he does office staff such that it takes 3 weeks to get a Prior Authorization for an MRI of my Pituitary Gland.  I am STUNNED he calls himself a Doctor and not a Medical Businessman.  I haven’t terminated our relationship yet because I’ve had a hard time finding another endocrinologist in my insurance plan who can see me within six (6) weeks and, anyway, at this point in our relationship he is merely accumulating test results and my Bookie could basically do that.  However, I will change endocrinologists when interpreting said test results becomes of paramount concern and a long-term treatment strategy must be devised.

Since I am seemingly caught in this weekly vortex of needing to be treated by one medical specialty doctor after another, I don’t have the energy to take the appropriate consumer “stand” with each disappointing health care transaction I encounter.  However, despite my medically dominated day-to-day life and the numerous disabling medical issues I must contend with, there was something so outrageous about my recent encounter with this Eye Doctor that I had to “fight back” if only to show this doctor that the BS he is pulling with other patients can’t be pulled with me (and shouldn’t be pulled with the other patients).

Do you “take,” or “participate in,” my Health Insurance Plan?

You see, I had to find an eye doctor who would not only evaluate my vision but also assess the various eye ailments I’ve experienced because of my chronic illness.  In that regard, a trusted family member of mine recommended this particular eye doctor because he was very kind to her and had solved her then-pressing medical problem so I checked to see if he was in my health insurance plan.  I was pleasantly surprised to see that he was IN FACT, an “In-Network” Physician Provider.  I point out this distinction because patients get fooled all the time when they call a doctor and ask them if they, for example, “take Green Cross of Boston Health Insurance” and the $12 an hour receptionist says, “Sure, the doctor ‘participates’ in practically all health insurance plans” or “the doctor ‘accepts’ all health insurance plans.”

You may not realize it at the time but “magic words” are exchanged between patient and medical receptionist during such a conversation and medical practices have been profiting off of the resulting misunderstanding with the same ease of off-shore oil drilling companies obtaining licenses to drill for oil under President Bush’s administration.  The medical receptionist technically said nothing wrong because saying the doctor “participates” or “accepts” all health insurance plans when asked if the medical practice “takes” a certain health insurance plan is like pulling into a gas station asking if they “take” the local town Entertainment Discount Card and expecting a great bargain if they do.  The gas station guy would say they do “accept” the Entertainment Discount Card but the rub is the extent to which he “participates” in, or “accepts,” the local Entertainment Discount Card plan.

The Financial Ramifications of Healthcare “semantics”

For instance, the gas station guy might smile and take the Entertainment Discount Card Coupon but after you fill up your gas tank for $49.00 he will come back to the driver-side window and tell you the total is $44.00.  “But I thought you ‘accepted’ the gas coupon from the Entertainment Discount Card?” you ask.  Still smiling as if he’s a regular Saturday night dinner guest at your house, he says, “I do, and I deducted $5.00 off your total, so all you owe me for filling up your car with gas is $44.00.”  That’s exactly what happens in healthcare when the words “participate” and “accept” are misunderstood.  Moreover, medical practices exert zero effort to correct patients from relying upon these magic words.  But we patients have no-one but ourselves to blame because the only phrase of any financial significance is “In-Network Provider” because then the most you can pay for an Office Visit is your “Insurance Co-Pay.”  With my current insurance policy, that is $30.00 for an “Office Visit” and $50.00 to see a “Specialty Doctor;” however, I have yet to see an Office Visit which they classify as anything but an office visit with a “Specialty Doctor.”

Having been burned many times before by the aforementioned health insurance “take/participate/accept” semantic BS, I was legitimately impressed that my Health Insurance Plan had this particular Ophthalmologist in its Provider Network of Doctors given the rave reviews he had received from someone whose opinion I respected.   Since my Co-Pay is $50.00 to see In-Network Specialty Doctors, I was going to get a full Eye Exam and Overall Consultation for no more than $50.00.  Looking back on it, I should have realized that when something sounds too good to be true, it invariably always is.  There are a few exceptions to this age-old axiom but you usually wind up marrying them and I have yet to be so lucky to meet the woman of my dreams. In any event, when I walked into this new Ophthalmologist’s office last Friday what I encountered SO DISTURBED ME that after the Office Visit I decided to ask for my money back.

How to be a Medical Patient Consumer

Rather than bore you with additional details as to why I felt so ripped off as both a Patient and a Consumer by this Ophthalmologist, I have pasted below the EXACT Fax I sent to him on the following Monday, which he responded to within one (1) hour by reversing the $50.00 Co-Pay charge to my American Express Card.  In short, I felt like a patron at a trendy restaurant with a Server who starts walking away from me while I’m still ordering as if he knows how to complete my sentences and what I want for dinner that evening.  The Server seems more interested in maximizing his tips by “turning the table over” rather than in ensuring that I have a pleasurable experience.  In the restaurant setting, I can tolerate such behavior because I don’t have to jump through too many hoops to find the joint and after all, it’s common to have a “one-off” experience.

If I wind up having a bad consumer service experience, I’m also always aware of the “buyer-beware” credo and I can easily “complain” by never going there again.  I can also tell all my friends about how rudely I was treated and I can even write a scathing Yelp Review or share my bad experience on some other social media platform.  These common sense remedies notwithstanding, I think it is just as important to take the time to compliment a new restaurant or business via these same consumer tools when the experience is positive.  We all seem to have more time to complain and protest to get our money back than we do to compliment or praise a business or service when it provides exactly what it advertises.  That’s just human nature and when we spend our hard-earned money and in return get a bad experience we tend to be more “motivated” to do something about it even if that is to simply ease our minds.  But I do try to keep my complaints and compliments in balance and I think my Yelp profile can attest to that.

But these consumer remedies are not as effective when it comes to our Health because there’s simply too much subjectivity involved with the healthcare transaction and the “time spent” vs. “proper treatment received” quotient doesn’t leave much room for a grave error or a disconnect.  Accordingly, while an arrogant abrupt physician to some can simultaneously be touted as a highly skilled and confident physician to others, the time invested in developing a new doctor-patient relationship gone wrong can feel like the most squandered of wasted time.

“Quantity over Quality” In-Network Doctors with some Exceptions

Ironically, in the middle of writing this Post I went to see an In-Network Surgeon for a Consultation as I need rather serious surgery to repair Crohn’s Disease-related damage in my Intestine.  It may have been the most thorough examination I’ve ever experienced as this doctor focused on me and my case until he and I were both satisfied that we had all of our questions answered.  By agreeing to operate on me, he was telling me that my problem was now his problem and I left his office SO relieved.  Perhaps it was the combination of the precise nature of his surgical specialty and the seriousness of my surgery which warranted such individualized treatment, but I have found the recent increase in Insurance In-Network Doctors clearly creating a “quantity over quality” atmosphere.  I can only imagine this trendy restaurant-like atmosphere to be a byproduct of the unreasonable provider reimbursement amounts and the allotment of shorter and shorter patient time constraints placed upon them by both our overall healthcare system and by the rules of being an In-Network Provider; the Network of which many Provider Doctors are forced to join simply for cash-flow purposes.

“Turning over patients” seems to be the name of the game in these types of practices.  It is quantity over quality; “LA” instead of New York City; Kathy Griffin over Louis C. K.  The question then becomes:  What to do about it?  I decided to articulate my grips in a respectful letter to the aforementioned Ophthalmologist asking for my money back and in the process I hoped he “gets it” so that the quality of the medical services he renders to other patients in the future gets better.  Below is that redacted copy of the fax I sent him [underlined and bold emphasis left in].

The Redacted Ophthalmologist Letter seeking Refund

As an experienced Patient, and a complicated one at that, I was deeply disappointed in the Ophthalmology medical services you provided to me on Friday, ————, and as I result I am reversing my $50.00 ——————– Insurance Co-Pay Charge with American Express (if charged; if not yet charged I am respectfully requesting that you do not do so) and I respectfully request that you mail to me my Medical Records you and your staff generated on ————-.  My address is —————————————————————.  Thank you for your anticipated cooperation.

For the sake of explaining my actions and for the purposes of hopefully preventing this from happening with other patients, set forth below are my  specific Complaints.  In summary, I just need my Doctors to be reasonably thorough and reasonably comprehensive given how pervasive my Crohn’s Disease has been and you clearly were not.  But, it is nothing personal.  Candidly, I think it is a byproduct of the ridiculous and unreasonable time constraints you are placed under by Health Insurance companies which in effect unfairly place your emphasis on “turning over patients” like waiters in a trendy restaurant instead of treating each patient with the time and focus warranted by each individual patient and case.  Nevertheless, I need more attention focused on the health of my eyes given that my Crohn’s Disease has already had a significant effect on my eyes.  In that regard, I must now see another Ophthalmologist for the same reasons I went to see you and therefore I would appreciate you not charging me for the ————————— Office Visit/Exam or not contesting my reversal of said charge when/if it appears on my American Express Card.  Thank you for your anticipated cooperation.

The Specific Patient-Consumer Complaints

  • I completed your New Patient forms in reasonable detail explaining the Cataract Surgery, Eye Sores, Extreme Crohn’s Medication Side Effects and Dry Eye I have experienced as a result of my Crohn’s Disease yet you merely confirmed the Left Eye Cataract Surgery and told me I have a Cataract in my Right Eye but that I shouldn’t worry about it.  That gave me no gauge whatsoever as to the status of that right eye Cataract considering that my Los Angeles, CA Cornea Specialist told me 3 years ago that I must watch that right eye CAREFULLY.  You did not even inquire about the eye sores or the Dry Eye and both are often symptoms of Crohn’s Disease and in my case they were so EXTREME to the point where I had CUTS in my eye that were so painful I almost had to be hospitalized.  As for the Dry Eye, I had some type of ducts inserted into each eye yet you did not inquire about Dry Eye AT ALL.
  • I spent more time with your cordial Vision Technician than I did with you and that concerned me given the complexities explained above and given my current exacerbating problems regarding Reading up-close.  I was worried that my chronic illness might be somehow affecting my vision (as my Crohn’s is apparently active and wreaking havoc inside my Intestines as I am awaiting a surgical date to have FIVE (5) Strictureplasties performed on me) yet I was “run through the mill” that you have established at your practice and while that may be perfectly fine for normal patients it doesn’t work for me.  I also asked this Vision Technician several questions which she had no answer for and I also had to remind her several times to check the prescription on my Sun Glasses as I was not sure when I had them made.  She was very nice and professional but she went through my exam like she was completing a checklist fixing a car’s Transmission rather than treating ME as a Patient.  I don’t blame her at all; I have no one other than you to blame because she should not be placed in a position to answer questions which necessitated answers from an Ophthalmologist.
  • When you gave me the eye exam and I complained that my right eye was VERY blurry from the dilation eye drops yet my left eye seemed fine, you said I shouldn’t worry that the vision you were demonstrating for me in that right eye wasn’t the best possible vision I could achieve with a prescription.  To that end, I still don’t understand how you were able to almost perfect the vision in my left eye with the manipulation of the different lenses in that machine but never came anywhere close to providing me with decent vision in my right eye.  Considering I have a small or “beginner” Cataract in that right eye, have experienced all of the above related to my Crohn’s Disease and what I set forth in the New Patient Forms, your answer to my repeated question about this was unsatisfactory.
  • I also told you after you were done examining me that I was having serious problems reading the newspaper and you told me that you were surprised by that statement based, I imagine, on the eye examination you had conducted.  Then, in response to my statement and in an attempt to help me, you had me go back to the prescription “machine” and you held up a sign close to the machine for me to read to test my reading vision.  However, your hand was not steady and the sign moved and that just added another variable to figuring out what my correct reading prescription is because I couldn’t focus on the answers to your questions regarding what was on the sign but you did not seem bothered by it.  You then put the sign down and changed my reading glasses prescription.  I asked how you knew what prescription to write and you simply answered: “I made your reading glasses much stronger.”  ????  With all of the complexities that must go into figuring out the correct eye prescription, what does “much stronger” mean and how did you arrive at that exact prescription?  Moreover, had I not insisted that you please make sure my reading vision was optimized; you would not have changed a thing.
  • I asked you about the right eye Cataract and again you gave me a “wishy-washy” answer by telling me “not to worry about it.”  Given the almost 20 major surgeries and 200+ hospitalizations I have experienced due to my Crohn’s Disease, I must worry about it because what can go wrong with respect to my health, always seems to go wrong.  This is all not even mentioning that I developed, and had surgery for, a Cataract in my Left Eye in July, 2007, when I was 44 years old and was told it was directly due to my Crohn’s Disease because I was too young to be developing a Cataract.  I was also told at the time that I had what appeared to be a Cataract in the right eye but that it was too small to operate on – at that time.
  • Then you walked out of the Exam room leaving me on the chair and I thought you were either coming back in or having another vision technician come in as I still had questions regarding the prescription to my Sun Glasses.  Then, after waiting a few awkward minutes in the exam room chair, I walked out of the exam room and asked someone to check my sunglasses.  The Vision Technician who had conducted a variety of tests on me was kind enough to take them from me and she then checked them.
  • I also recall always having drops placed in my eye to reverse the dilation drops because my eyes are SO SENSITIVE to Dry Eye and whatnot but that was not done and I forgot to ask.  As a result, I had trouble seeing clearly for at least FOUR (4) hours after I left your office.

Dr. ——–, I could go on and on but it is not my intention to be unreasonable or vindictive.  The whole experience simply reeked of an office trained to “turn over” patients rather than to TREAT THEM and I cannot entrust my health and well-being to such a Doctor.  That said, I am acutely aware of the harsh realities of our current healthcare system and I do sincerely understand the ridiculous reimbursement and time constraints you are up against but nevertheless I do hope you take this letter in the spirit in which it was written.  That is, to explain my actions and to provide you with some feedback so that you can make some changes to provide a better quality of care to your future patients since you certainly seem like a smart doctor with the best of intentions.  Additionally, I do not think it is fair that I should have to pay for my eye exam with you since I must now go to another eye doctor for the same thorough and comprehensive eye examination I was seeking.

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Posted in Assertive Patient, Doctor Patient Relationship, Doctor Ratings, Doctors, Empowered Patient, Health Insurance, Health Insurers, Informed Patients, Patient Consumers, Patients as Consumers, Physicians as Service Providers, The Empowered Patient

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What to ask before your 1st Crohn’s Disease Surgery

Posted on May 3, 2012 | 4 Comments

The Power of Crohn’s Disease

As a 49 year-old battling Crohn’s Disease for almost 30 years, people always ask me two (2) things:  1. What is so unique about Crohn’s Disease which makes surgery such a last resort?  2. Why has it been necessary for you to be hospitalized over 200 times for treatment of Crohn’s Disease?  The answers to these two (2) questions set up a foundation of knowledge that every Crohn’s patient should acquire so they are properly equipped to most effectively interact with their surgeon during that 1st surgical consultation.  But before I share advice about what to ask your surgeon before your 1st Crohn’s Disease surgery, I think it is also important to understand the disease, its possible progression, its medications and its potential effects on your life.  That’s why I’ve chosen to write this “advice article” from a story-teller perspective.  After all, surgery is surgery but there’s nothing quite like Crohn’s Disease.

Experienced Crohn’s patients are not Doctors but for what we must go through with the disease, we might as well at least have some type of Honorary Medical Degree! To that end, Crohn’s Disease forces each of its patients to learn a great deal about his or her respective “type” and intensity of disease since Crohn’s can affect one person mildly yet another so severely that he or she can be disabled.  There is no medical explanation for this wide and diverse range of brutality. Moreover, these mild vs. severe flare-ups and overall Crohn’s classifications can inexplicably go away over time or they can exacerbate.  The auto-immune element of Crohn’s can also introduce other chronic diseases and conditions into the patient’s situation and these Crohn’s “related” medical problems can be more debilitating than the vice-like grip Crohn’s itself often has on the life of its patients.

When you also consider the life-threatening and life-style altering side effects of some Crohn’s Disease medications, the potential severity of the disease really comes into focus. Like many other Crohn’s patients, I have come to experience it as a disease which has a mind of its own whose main attributes are unpredictability and in-curability.  How can a person plan a life around such an often pervasive disease which causes debilitating and painful flare-ups the timing of which are unpredictable? Oh, and the underlying disease is incurable? There are many more dangerous and debilitating diseases than Crohn’s Disease but few feast on a patient’s physical, mental, psychological, emotional, financial, professional, social and familial well-being as much as Crohn’s Disease.

 A Correct Diagnosis of Crohn’s Disease

Assuming you are accurately diagnosed and manage to dodge the months or years of being misdiagnosed with people close to you thinking you are crazy for trying to associate together seemingly unrelated symptoms as if they are all a part of one horrific and existing disease (which they are, and the disease is called Crohn’s Disease), you’ve ultimately found “the” gastroenterologist who fits your needs, personality and lifestyle.  During the first few years, under normal circumstances you would have likely been under medical treatment for a variety of Crohn’s symptoms that occur when your body’s immune system is ill-equipped to fight off inflammation.  In fact, when posed with the task of fighting inflammation, your Crohn’s Disease somehow confuses your immune system and causes it to attack itself instead of the inflammatory intruder.  This sounds like fodder for an old Jerry Lewis Comedy but the practical medical effects of this bizarre immune system malfunction make Crohn’s Disease potent and pervasive.

Despite the possible serious manifestations of Crohn’s, your gastroenterologist will start you off with the most conservative medical treatment and then gradually move you up that scale as your condition warrants.  But as you know, your condition may forever stay at that very treatable level or it can get rather aggressive like mine and that’s when your doctor has to move to more “systemic” medications or eventually have you consult with a surgeon about surgical intervention.

Crohn’s Disease Recurs which tends to negate Surgery

In answering Question 1 above, it’s important to understand that Crohn’s Disease tends to “recur” in that, by way of example, having surgery to remove 4 inches of diseased small bowl intestine might solve your pressing medical problem but the mere act of surgical intervention could start the need for continued removals or surgical repair of additional small parts of small bowel intestine.  The problem with that is there is only approximately 23 feet of small bowel in the human body and your small bowel is a very important piece of human equipment. Personally, I had a small bowel resection surgery which fixed an extremely painful then-pressing Crohn’s flare-up only to have Crohn’s come back or “recur” and affect the same area of my bowel a mere two (2) months later.  After almost another two (2) months of aggressive medical treatment to try and avoid another bowel surgery, this Recurrence of Crohn’s Disease in my small intestine required another surgery to remove more of my small bowel only one hundred twenty (120) days from the date of the prior small bowel surgery. Additionally, and as referred to above, the 23 feet of small bowel serves several different important bodily functions such as digestion and absorption of nutrients so each time a portion of the small bowel is surgically removed or altered, the patient will have to make significant lifestyle adjustments to remain healthy and appear normal.  There is also the reality that every surgery creates scar tissue or adhesions and these natural byproducts of surgery can, by themselves, cause Full or Partial Bowel Obstructions necessitating even more surgery.  This additional surgery creates more scar tissue to the point where a viscous cycle forms such that the following credo was created: “more surgery begets more surgery.”  In summary, these recurrence issues are the reasons surgeons don’t like to perform surgery to fix or repair Crohn’s Disease damaged intestine.

Crohn’s Disease Medications

Prior to having to consult with a surgeon, the traditional Crohn’s Disease treatments and medications with which you might be familiar generally fall within the different levels or degrees of the disease and are as follows:

Anti-inflammation medications: (Asacol, Dipentum, and Pentasa);

Cortisone or Steroids: (Prednisone, Budesonide);

Immune system suppressors: (6-mercaptopurine [“6MP”], azathioprine, Methotrexate, and Imuran);

Biologics: (These are injectable “Anti-TNF” Agent medications such as Remicade, Humira and Cimzia which have been proven to be very effective pursuant to current Crohn’s research.  More specifically, the most current research indicates that the injection of these drugs binds them to “TNF” substances and that will block the body’s abnormal inflammation response. Some studies also suggest that the usage of biologics may enhance the effectiveness of immuno-suppressive medications. While I can attest to the almost dramatic positive effects of some biologics, I can also attest to the fact that the use of biologics in Crohn’s Disease can have VERY serious long term side effects many of which are only now first coming to the attention of medical practitioners.  It’s one thing to be aware of these terrible consequences due to the  small print [or fast spoken] legal disclaimers on the packaging inserts [or in TV/Radio commercials] of the biologics but it’s an entirely different reality when these patients taking biologics start showing up in emergency rooms around the world with life-threatening Lung Disorders and Fungal Infections.  Almost forget, these biologic drugs tend to also be very expensive.)

Antibiotics: Antibiotics are used for a variety of purposes in Crohn’s Disease because in some patients doctors believe there is a bacterial component somehow involved.  They are also used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or surgery. Accordingly, your doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, metronidazole [i.e., Flagyl]. (Personal Note:  For whatever reason, Flagyl has proven to be VERY effective for me during certain types of Crohn’s flare-ups.  In such instances, I typically take the antibiotic for 5-10 days and then get off of it.  I mention this because even the use of antibiotics in Crohn’s patients can have serious complications such as the prolonged use of Flagyl causing Pancreatitis. Again, I am NOT a Doctor but I have been in contact with many Crohn’s patients who have contracted Pancreatitis after significant use of Flagyl.  Amazingly, I have thus far avoided that nightmare.)

Anti-Diarrheal Medications & Pain Medications: These are drugs used routinely by Crohn’s patients for lifestyle purposes because no one wants to spend their days in pain or stuck in a bathroom.  Some patients even see specialty “Pain Management Physicians” to specifically treat their Crohn’s pain. Whatever the reason, you should always tell your gastroenterologist what medications you are taking because this information will help him or her in devising your overall medical treatment and it will also be an important piece of information your surgeon will want to know about.

Why so many Crohn’s Hospitalizations?

In answering Question 2 above, I tell people my doctors are always doing whatever is necessary to keep me off the operating table for the “disease recurrence” reasons described above.  The practical result in the 1980s and 1990s were increased hospitalizations although due to subsequent changes in healthcare and in the health insurance industry, I’m not so sure I would have been hospitalized as often or for as many days each time I was hospitalized if I got as many of the same type of Crohn’s flare-ups now in 2012.  In any event, since there are a variety of effective Crohn’s Disease medications, many of which I outlined above, I was thus often hospitalized to take these medications intravenously or in combinations/strengths which are not available outside the hospital.  In that regard, my gastroenterologist preferred seeing me in the hospital, sometimes for 20 days, if necessary, in an attempt to get me through a flare-up with the administration of medications rather than through surgical intervention and the likelihood of losing more of my intestines.  I’m not so sure health insurance companies would now agree with this safe and conservative approach since they like to “turn over” hospital beds like waiters turning over tables in a trendy restaurant to maximize their tip income.  In any event, doctors still follow the same conservative medication principles but more of the patient “response time” is done at the patient’s home due to the increased cost of being hospitalized. This harsh reality of a Crohn’s Disease flare-up adds to the feelings of loneliness and isolation which many Crohn’s patients unfortunately experience.

Finding the RIGHT Crohn’s Surgeon FOR YOU

I have gone through this short summary of Crohn’s Disease treatments and medications because I think a 1st time surgical Crohn’s patient should be familiar with the possible roads not taken and with all that is involved in leading up to Crohn’s surgery.  The 1st time surgical patient should also know that when they consult with a surgeon and their gastroenterologist thinks they need surgery, they are likely going to receive a recommendation of surgery since that is what surgeons do!  Of course, there are numerous exceptions to this but my point is that you want to make sure you’ve exhausted all possible medical treatments such that the only appropriate answer to your Crohn’s problem IS surgery.  If you’ve arrived at that point, then your only responsibility is to pick the surgeon who is right FOR YOU.  This means consideration of skill level, personality, understanding of your lifestyle and of the quality of life you are seeking by having the surgery.  You also need to go through a battery of diagnostic tests prior to the surgical consultation and your gastroenterologist will naturally order these tests in trying to help diagnose you.  It has been my experience that surgeons like to look at the actual Films from a CT Enterography and a GI Series.  Depending upon your medical/financial and health insurance situations, you may have to undergo additional testing.  Regardless, try to always obtain the original Films from each test so that the surgeon you ultimately choose can use them to successfully operate on you.

The Crohn’s Disease Surgeon – What to Expect

It’s difficult to recommend questions to ask a surgeon in a Crohn’s Disease case because with few exceptions every surgeon I’ve ever encountered has been SO confident and thorough that they leave little room for elaboration.  Sometimes, however,  this “confidence” can be construed as arrogance but I’ve also come to learn that with supreme surgical skills in Crohn’s cases comes a certain “self-assuredness” which can be off-putting if not expected.  For example, these surgeons bring up money and the cost of the surgery earlier in the doctor-patient consultation than in any other medical situation I’ve ever encountered.  Again, there’s nothing wrong with making sure you will be paid promptly for providing your services but such “directness” during a medical consultation may be a turnoff to you.  If that is the case, please at least take away from the encounter that Crohn’s surgery is SERIOUS BUSINESS.  The surgeon is being asked to basically take apart your insides and then put them back together sans the Crohn’s problems.  If, even with that understanding, you don’t feel comfortable with that particular surgeon, look elsewhere but don’t forget you will encounter some aspect of this self-assuredness in almost every surgical consultation.

The Crohn’s Disease Surgeon – What to Ask

Prior to actually meeting the surgeon for the 1st time, you should write out your questions so that you are organized and respectful of his or her time.  You should also have a written list of all the medications you are taking. Every surgeon will appreciate you doing this.  However, LISTEN to them first and even take notes before you ask your pointed questions as they are accustomed to the nervousness and anxiety of 1st time patients and thus they are usually overly  comprehensive in their initial explanation of the surgery.  Besides the obvious questions related to the surgery such as the possibility of doing your procedure via laparoscopic surgery (i.e., instead of cutting your entire torso open), the estimated recovery time and the amount of pain involved, you should inquire about post-operative care and about the subsequent limitations in your work and physical activities and when you can start instituting your dietary preferences. Ask about the most likely problems which will be encountered with your particular surgery and what the ramifications would be to you if such problems occurred.  Getting back to the pain issue, I would ask about the availability of a Pain Management Team at the Hospital if you are overly sensitive to post-operative pain because Crohn’s surgery can be among the most painful surgeries performed. (For example, a day or two after my 1st Crohn’s surgery, a kind nurse gave me a pillow on which she had written what I thought were “girly” drawings and she told me it was my “Cough Pillow.”  I thanked her for her thoughtfulness but put the Cough Pillow as far away from me as possible in case one of my macho buddies stopped by to see me and found me cuddled up asleep with this girly pillow.  Well, after the first inclination to cough hit me and I tried to cough but nearly passed out from the pain, that Cough Pillow and its girly drawings NEVER left my side and I didn’t care who saw me use it!)

Always keep in mind that this very confident surgeon may have to attend to you when you’ve had an unsuccessful surgery and he or she will need to “problem-solve” to get you better.  Confidence is great but empathy and adaptability are also important.  Be realistic with what you expect from the surgery and make sure you are both “on the same page” with your expectations and the surgeon’s capabilities/intentions.  Understand the various costs involved with the surgery such as the Surgeon, Anesthesia, Hospital, Laboratory, etc.  The Surgeon will not be able to break down the other costs but the office staff will probably know from whom you will be receiving medical bills. Lastly, if this is the surgeon you choose but the price is too high, ask if there is a payment plan available.  It may feel strange negotiating over life or life-style saving surgery but you must and that’s why I think it is also always best to bring along someone (e.g., your mother, brother, sister, best friend, etc.,) who will respectfully act as your Patient Advocate of sorts because you will certainly need one when you are incapacitated from the surgery.  More to the point, it is always easier having a “buffer” to ask about or respectfully demand those difficult items or issues which you don’t want to get into a heated conversation about with the surgeon who will be presiding over you at your most vulnerable condition.  Besides offering you moral support, that Patient Advocate can more easily objectify the “transaction” just as the “self-assured” surgeon can since he or she has presumably done this hundreds or thousands of times before.

Now, you are ready for surgery.  Good luck.

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Posted in 1st Crohn's Disease Surgery, Anti-TNF Agents, Assertive Patient, Auto-Immune Disease, Crohn's, Crohn's Disease, Doctor Patient Relationship, The Empowered Patient

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Saving Money by “Working” Your Health Insurance Plan

Posted on April 22, 2012 | Leave a comment

 Having Health Insurance these days isn’t good enough.  You must know how to “Work” your Health Insurance Plan to best maximize your preferences and financial expenditures.

 **This Video is a summary of a Chapter in the upcoming eBook, “Chronic Illness:  Truths, Tales and Tips” by Michael A. Weiss.  The eBook is set to be ready for distribution during the Summer, 2012.

 Mr. Weiss is also the author of “Confessions of a Professional Hospital Patient” presently available at Amazon and Barnes & Noble.

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Posted in Dealing with Chronic Illness, Doctor Patient Relationship, Empowered Patient, Health Insurance, Health Insurers, Informed Patients, Managing Chronic Illness, Professional Patient, The Empowered Patient, The Medical Minute

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REAL Healthcare Reform = ObamaCare + eHealth + mHealth

Posted on January 25, 2012 | Leave a comment

ObamaCare is looked upon both positively and negatively as the end-all / be-all of Health Care Reform in the United States.  It is politically charged and subject to nationwide debate and likely repeated judicial challenge.  However, it need not be so divisive as it seems to have actually inspired and triggered other significant Healthcare reforms and Healthcare entrepreneurial advancements via legitimate Free Market Solutions, namely, “eHealth” [Electronic Health] and “mHealth” [Mobile Health].  This 4-Minute Video explains this interesting and ongoing technological development in Healthcare Reform.

 This is part of my “Two Minute Drill” Series of Healthcare Videos.  The phrase is taken from the NFL, i.e., United States Professional Football, and refers to that intense time of the last 2 minutes of the end of the 1st Half, or of the Game, when teams use a no-nonsense carefully timed 2-Minute Drill to most efficiently move down the field to score points.  With Television Commercials, the 2-Minute Drill often takes 10-15 minutes of “Real Time” and thankfully that affords me the ability to still use the phrase when my succinct Videos are sometimes 4 to 5 Minutes in length.  I hope you enjoy the Healthcare Content and that it provides you with mental stimulation and creative inspiration.

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Posted in 2-Minute Drill Video Series, eHealth, Electronic Health, Electronic Medical Records, EMRs, Health Insurers, Health Technology, Healthcare Mobile Phone Applications, Healthcare Reform, mHealth, Mobile Health, ObamaCare, Patient Protection and Affordable Care Act, Practice of Medicine and Consumer Law, The Empowered Patient

Ingredients for Change – The “Voices” of BOTH Student College Athletes & Medical Patients

Posted on September 17, 2011 | Leave a comment

With Student Athletes at Mainstream Collegiate Athletic Programs, the time has finally come for them have a “Voice” in how their rights are established and managed.  The sad reality is that breaking new ground with their rights will be as realistic as seeking sympathy from the devil.  But given how much money they generate, the National Collegiate Athletic Association (the “NCAA”) will soon have to at least “go through the motions” of listening to them because that exercise in futility is far less expensive than implementing change.  This got me thinking to my status as a “Professional Hospital Patient” and about the Hundreds of Thousands (or even Millions) of Chronically Ill Patients around the world.  Just like the Student Athlete is the Asset by which all other collegiate sports issues revolve around, the Medical Patient Voice is the benchmark of global healthcare Patient outcomes and also the standard of healthcare Consumer expectations.  Let’s be serious for a moment: the “Patient Voice” is so much more important than that of Student Athletes because Duration of Lives, Quality of Lives and Choices in Lifestyles and Professions are directly affected by healthcare decisions, laws, mandates and “Influencers.”  Thus Patient Voices MUST BE CONSIDERED in moving forward with Global Healthcare.  After all, who else knows what it is like to be a Patient?  Who else knows if the current Patient programs and protocols in place are maximizing Patient care?  Physicians?

Let’s see about that.  A few years ago in 2000 or thereabouts, when I was considering writing my Book, “Confessions of a Professional Hospital Patient,” essentially chronicling what goes on inside a Hospital hour-by-hour from a Patient Perspective, I began discussing the idea with a Physician-colleague at the wind-down of a local chapter Board Meeting of the Crohn’s & Colitis Foundation (“CCFA”).  While I have my issues with the politics of how the CCFA is often run, I sincerely applaud their efforts at helping people like me who must somehow manage life despite the increasingly pervasive challenges posed by Crohn’s Disease. I especially appreciate the volunteers who give of their time to help me in this battle.  THAT is the most selfless act a person can ever do, i.e., to give of themselves to help others expecting nothing in return.  I wish I could say the same for this Physician but he arrogantly started to question my veracity on the subject matter of being a Hospital Patient such that I could even qualify myself as an authority or “expert” to write such a book whereas he, as a Doctor, and seemingly an inherent authority on the subject matter, was more qualified.

At that point in my life I was hospitalized over 100 times for my Crohn’s Disease so I felt I had a solid authoritative voice on the subject matter and this Physician was familiar with my struggles in this regard so I did not understand why he was challenging me in front of the entire Board of Directors of the CCFA.  So I asked him how much time he spent, on average, with a patient during a hospital visit?  He replied that he wasn’t sure but it couldn’t be more than Six (6) minutes or so due to health insurance company rules and regulations.  I nodded my head in agreement that medical professionals are severely limited by such health insurance company rules and regulations but then I asked this Physician: “What then makes you think you know what goes on with a Patient inside a Hospital the other 23 Hours and 54 Minutes of the typical day?  Don’t you think that an experienced Patient like me has just a little more first-hand knowledge on this particular matter than you do?”

Mr. Know-It-All-Physician took a deep puff of his misogynistic almost-prop-like cigar and out of the corner of his mouth dismissively answered my question but did so addressing the rest of the Board so as to make a mockery or our conversation by saying: “That’s why I rely upon my Nurses.”  His physician-colleagues smirked as he packed up his materials to leave, since the meeting was winding down and our conversation was informal, but I smiled and retorted, “Thank God for Nurses because it is their system of ‘Reporting’ which ensures Continuity of Care for Patients like myself because if we Patients had to rely upon condescending physicians like you we’d be screwed.”  The room went silent and he turned to me and stuck out his hand and said, “Good luck with that Book, son.”  From my perspective, insulting and demeaning someone and then sticking out your hand as a symbol of “let’s agree to disagree on this” is akin to sending the woman you love flowers only when you are apologizing for something.  It is a meaningless gesture intended for cosmetic purposes only.  Additionally, as I was 38 years old at the time with a Law Degree and an MBA, and this arrogant Physician was well aware of my professional qualifications and skills having been the beneficiary of them on a few occasions, I just smiled and continued packing up my stuff and felt no need to shake his hand.  That was my way of saying, “You arrogant schmuck, I feel sorry for your patients.”

In terms of more recent examples of the importance of Medical Patient Voices you need look no further than September 16, 2011, when the well-respected News Resource, “NPR,” published an article written by Scott Hensley entitled, Doctors Call For Pullback On Narcotics For Chronic Pain, which was based on the findings/opinions of THREE (3) Doctors who published an editorial on the matter this past week in the Archives of Internal Medicine.  Instead of using narcotics for the management of chronic pain, these evidently healthy doctors advocated talking with patients about the limits of pain relief and give alternatives to opioid drugs, such as physical therapy or yoga, their due. Yoga?  Huh?  Are these doctors from Venice, CA?  Have these doctors ever been patients besides the day they were born?  Have any of these doctors seen the fabulous movie starring William Hurt entitled, “The Doctor?” Do any of these physicians have personal experiences with chronic Fibromyalgia, Arthritis, Spine-Fusion Surgery, Constant Back Pain, numerous surgeries, immune-suppressive Diseases such as Crohn’s Disease, Lupus, Pulmonary Fibrosis, etc.?

Do they even understand that a KEY ROLE of Pain Management is for the chronically ill patient to be able to nevertheless maintain a quality of Life without having to be admitted to the Hospital for Pain Relief each and every time their pain rises to the level that a Tylenol or a Rolaids cannot help them with?  Do these short-sighted doctors realize that it is even economically prudent to permit Pain Management to function in this regard as it is less expensive to dispense and monitor the narcotics than it is to admit patients to hospitals?  Or do they have such little pride in their professionalism and are so lazy that  taking the “path of least resistance” is their solution to this problem when a few bad apples of drug addicts and/or drug dealers are spoiling a Quality of Lifeline for Hundreds of Thousands of Patients suffering with chronic pain?   Do they also not realize that their actions have such far-reacting consequences that National Chain drug stores such as Rite-Aid don’t even stock the powerful, long-lasting narcotic, Oxycontin, due to the aforementioned potential abuse situations?   I only learned of the Rite-Aid situation last week when I innocently walked into a store near my Pain Management Physician’s office seeking to fill my prescription for Oxycontin only to be essentially thrown out of their store under the presumption that I was a drug abuser or drug seller.  I felt like Leper thanks to the effects of a few spineless comments in the media made by just a few Pain Management Physicians.  These days, I guess, Patients in true need of FDA-approved Pain Relief drugs are made to feel like criminals.  What a fool I was thinking it was hooded sweatshirt when all along it was my FDA-approved prescription!

In fairness to the author of the NPR article, namely, Mr. Scott Hensley, a retort was obtained from Dr. Robert Chou, who heads the group at the American Pain Society working on guidelines for clinical practice.  Mr. Chou was then quoted as saying:

While it’s important for clinicians to be more thoughtful about who they prescribe long-term opioids to and to stop opioids when they aren’t helping or there is evidence that it is causing problems, the American Pain Society believes opioids have a role in the management of chronic non-cancer pain in carefully selected and monitored patients.

There is evidence from long-term observational studies and evidence coming from some long-term clinical trials that opioids are effective for improving pain in some patients.

For example, we do not believe that a trial of low doses of opioids should be denied to a low-risk woman in her 70′s who has severe hip arthritis, who may be able to garden and walk with decreased pain on it.

While the data on overdose deaths and abuse of opioids should concern all members of society, it does not justify an extreme blanket position of no opioids for chronic non-cancer pain.

Just so no one can accuse me of being a mere spineless “opinion,” I have been a chronic Pain Patient for over 25 years who is “dependent” on narcotic pain medications through the careful administration and watchful-eye of Pain Management Specialists for treatment Severe Crohn’s Disease which has necessitated almost Twenty (20) serious surgeries, depleted my immune system such that I now have Bronchiolitis Obliterans with Organizing Pneumonia (i.e., “BOOP”) and am in the middle of a course of Chemotherapy to treat this Life-Threatening BOOP Lung Condition as a 3-month daily dose of 60 mgs of Prednisone did not cure the BOOP and only caused a Crohn’s Disease Flare-up for which I can essentially take no medication because ALL “Anti-TNF Agent” drugs such as Humira and Cimzia are off-limits to me now since the Doctors believe my exposure to Humira and Cimzia in treating my Crohn’s Disease is why I came down with BOOP.  The resulting joint pain from the Crohn’s Disease Flare-up is so debilitating at times that without Pain Medication all I can do is lie down on a couch, cry and pray for the aforementioned mystical “Yoga” relief these spineless Pain Management Physicians are suggesting.  Maybe I am lacking special candles? Perhaps I need a different Yoga uniform?  In all seriousness, is it not torture and/or cruel and unusual punishment to withhold these drugs from me when my various painful conditions are painstakingly documented and I am seeking the medications from Board Certified Pain Management Physicians?

Lastly, the dangers of Doctors, Politicians and other people with easy access to mainstream media using Public Access forums to advocate medical policy is no more demonstrative than by the recent comments made by Republican Presidential potential Candidate Michele Bachmann on Tuesday, September 13, 2011, linking the HPV Vaccine to “mental retardation,” when she told NBC News she had heard from a woman who said her daughter “took that vaccine, that injection, and she suffered from mental retardation thereafter.”  All politics and other intentions aside, such manipulations of the Mainstream Media to affect years of scientific research is dangerous and absurd and can only lead to BAD MEDICINE.  Supposedly and scientifically, this HPV Vaccine has been proven to prevent Cervical Cancer when given to teenage girls.  Accordingly, advocating anecdotal stories that, if taken at face value, could KILL MANY WOMEN with Cervical Cancer, is no different than the aforementioned spineless physicians taking the path of least resistance with respect to Pain Management treatment when they have no scientific or personal date to back-up their claims. Oh wait, it is different.  Ms. Bachmann could be putting REAL LIVES AT STAKE!  Do people not see how dangerous this situation is and that this is the classic example of the “slippery slope” often referred to in law school   If Ms. Bachmann had relayed a “story” about, for example, Crohn’s Disease not being so pervasive and that too much of a big deal is made about it because a woman she met while touring the country told her so, I would be apoplectic.  This has to stop.

These stories are all crap and they are why Credible “Patient Voices” and Health Care Social Media (“hcsm”) platforms are more critical now than ever before.  It is why I will be participating in an interactive discussion and workshop, courtesy of WEGO Health, in the September 19, 2011 “Digital Health Coalition” being held in Philadelphia, PA, for the purposes of creating an “E-Patient Bill of Rights” for the global healthcare industry. I am looking forward to sharing my insights and to listening to those of others for only then will our healthcare system have a diversified set of Rights and Responsibilities to build upon.  Just like the Student Athlete is the Asset by which all other collegiate sports issues revolve around, Medical Patient Voices are the benchmarks of global healthcare patient outcomes and they are also the standard of healthcare consumer expectations.   I am honored to be asked to contribute to that meaningful conversation.

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Posted in Crohn's Disease, Digital Health Coalition, E-Patient Bill of Rights, Informed Patients, Patient Voices, Patients as Most Valuable Resource, The Empowered Patient

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Healthcare Significance of Google Health’s Demise & Possible Resurrection

Posted on July 12, 2011 | 1 Comment

The words “Demise” and “Resurrection” are clear contradictions in terms just as are the phrases “Kim Kardashian” and “Reality TV Actress.”  But that is exactly what Google unexpectedly ran into with its Google Health Initiative.  What started out as a seemingly hopeful Brand Extension into the “can’t miss” social media healthcare industry, which, let’s face it, is ripe with financial and growth opportunities for a savvy, behemoth company like Google, slowly morphed into that situation in high school when you bring your unbeatable 5-man hoops squad from the local Suburban Community Center into the big city to test its mettle against pick-up teams in the playground who leave no doubt as to the street smarts required to rule the game of basketball in the city streets, where the rims have no nets and even the little guys can jam the basketball.  Even your team’s leader, the tough, rebounding 6’10” Center with soft hands and a great shot gets painfully schooled by quicker Guards who aren’t nearly as tall or as talented but they understand the “hustle” of the game.  They “get” that winning is the only thing and participating with the better players on paper is useless without understanding the lay of the concrete courts.

Google Health had no idea that the profits hidden in all mainstream healthcare ventures lie in the gross inefficiencies hidden by the Health Insurers via Oil Cartel-like business practices with assistance from regulators who also benefit in one way or another.  These secret healthcare money-making practices and companies are guarded with such deep and formidable political cover that is only rivaled by the way in which Hollywood has convinced a global audience that Kim Kardashian is even a celebrity.  I think Google Health figured this out a little too late during the “Google Health 1.0” Initiative or somewhere around the 7th pick-up game of the day when even Ken Howard would have forced his “White Shadow” basketball team to pack it in to re-tool in order to fight another day. But “Coolidge” and “Salami” would live to come back another day to teach these playground players that a true “Team” with a well-executed and practiced plan can overcome even the biggest of odds.  After all, it was a TV Show which always ended with a message.

But who would have ever thought that with all its accomplishments on the web that Google would miscalculate a “David & Goliath” competition when they are actually “the David” and some Health Insurers “the Goliath”?  Sure, there’s more to Google Health’s recent demise but conceptually I think this is what Google learned and just like Coolidge and Salami, they will be back because how many other business situations with such big upsides will they be placed in the underdog role fighting for Right in an industry such as healthcare where their success is sorely needed to change the status quo and bring about meaningful healthcare reform?  I can’t think of any unless they decide to contribute to solving our national debt crisis.

Most medical professionals believe that all healthcare-related web initiatives are doomed to fail unless clinicians or other licensed medical personnel are a visible and significant part of the plan for roll-out, development and profitability.  This would seem to be an insurmountable barrier to enter the market for a company like Google Health which provided a Patient-Dedicated Service which stored and organized Medical Records. However, with the advent of “Health Care Social Media,” or “HCSM,” as it is frequently referred to as an acronym, something unique is developing on the web with healthcare involving Patients; and Patients only.  More specifically, as I learn more about HCSM, I think Chronic Patients like me yield a great deal of Influence in these healthcare web initiatives such that when a company as large, powerful and resourceful as Google gets flustered by not factoring this into their business plan and that miscalculation jeopardizes their entire healthcare initiative, this influential role of Patients in HCSM  needs to be examined and more carefully integrated into the business plan.

The fact is that Licensed Medical Professionals cannot yet participate in HCSM on a clinical individual Patient Care basis as their Licensure Boards, no matter how skilled, can’t keep up with the speed of Social Media.  This frustrating reality is applicable no matter how well intending these Doctors and Psychologists are with respect to branching out for the sake of being accessible for their Patients, and most are that selfless with what would be even more of a drain on their most precious of limited resources,namely, time.  As a result, they would leave themselves vulnerable to too many ethical, legal and moral cases of First Impression.  The smart ones heed the warnings of their attorneys and simply use HCSM to educate their Patients about new developments that affect their Patient Care and Patient populations.  Others use HCSM strictly for marketing purposes.  But some are also prematurely talking about ROI (i.e., “Return on Investment”) with respect to HCSM and thus trying to monetize HCSM before they even understand it.  However, as Apple Computer, Inc. taught us, we need to let the wine age a bit, the market define itself, then try to monetize it.

But lest we not forget that we are mostly talking about Doctors here, so they are bound to make the same mistakes their arrogant and greedy record company executive brethren made when faced with the same apparent opportunities to which Recording Artists, and in this case, Patients, also lay claim.  Although, I sincerely hope not because the younger Doctors I have been privileged to meet in the various virtual HCSM functions I have “attended” are SO SHARP and seem SO DEDICATED to Patient Care and to realistically regulating the Health Insurers who operate within the Health Insurance Industry utilizing the same unconcerned community-minded approach as the Oil Cartels that I am doing all I can to help them play a vital role in the development and growth of HCSM (and thus the emergence and re-emergence of Patient Medical Record Organization and Storage Services like Google Health).

To understand why HCSM is strictly a Patient-Driven Medium, you need to know that the only constraint on Patients sharing information and experiences with one another in HCSM is their own respective Privacy tolerance levels.  Personally, I don’t mind the world knowing that I have the incurable and auto-immune illness, Crohn’s Disease, and as a result, I have been hospitalized over 200 times and operated on almost 20 times.  I even wrote a Book about it called “Confessions of a Professional Hospital Patient” with the hope that others could learn from me sharing my information, experiences and lessons learned as I thought THAT was the Medium to disseminate all that I had learned.  A Service like Google Health offered Patients a place to safely aggregate their medical information so that it could be accessed easily by Medical Facilities and Medical Professionals all over the world thus freeing up Chronic Patients to live their lives to the fullest and never having to worry that a skiing accident in some faraway land could wind up a medical disaster where they would have to explain their unique medical condition to Doctors who speak a different language.  Even more important, a Service like Google Health would breed confidence in this type of Chronic Patient so that he or she actually goes on that trip or relocates to another city for a great new job opportunity without fear of being separated from their medical records.

An increasing amount of Patients understand the possible, if not probable, privacy tradeoffs to sharing their information and experiences in exchange for the same about their present health problem.  When they do so, they are creating Virtual Patient “Communities” of Empowered and Informed Patients with shared illnesses, symptoms, medications, complications, side effects, etc. When these Informed Patients tap into this almost instantaneous database of empowerment and consult with their real-life Physicians, the interaction is quicker, it is less intimidating for the Patient, the Patient Care becomes more collaborative in nature, and the overall Consumer Transaction is both more efficient and cost effective.  Amazingly, not one Clinician or Licensed Medical Professional was involved with the foregoing explanation of how a Service like Google Health would help in the transformation of “Patient 1.0” into the new “Google Health Empowered & Informed Patient 2.0.”  Accordingly, while it would seem counter-intuitive that Clinicians need be present to lend authenticity to a web healthcare venture, HCSM says differently and it is this underestimation which hurt Google Health.  In essence, what Google Health lacked was a modern-day Grassroots Marketing Campaign by Patients touting how useful the Service is to Chronically Ill Patients, for example, who can now travel the world knowing that all of their medical records are in one place and they need not wait for standardized Electronic Medical Records (“EMRs”) to be adopted worldwide.  And these days, Grassroots Marketing is akin to Social Media and thus it is powered by technology so it won’t take long for other Patients to get this message and find benefits of their own in these types of Services. Then, amazingly, medical professionals will come on board because that is where their Consumer Patients are.  Remember, ROI?

Therefore, the only ones dominating the HCSM playing field are Patients sharing information and experiences with other Patients for the betterment of their own Treatment as well as for the betterment of overall Healthcare.  This Patient empowerment will have a trickle-down effect which will be the Game-Changer we have all been waiting for in healthcare.   It is not going to happen as a result of healthcare reform as our political party system won’t permit the necessary changes without the other side neutralizing the effectiveness of any positive reforms.  But there is precedent for this type of success involving counter-intuitive traditional Grassroots Marketing effectuating broad-sweeping industry changes and in all places and industries it was set by a band in the Music Industry called “The Grateful Dead.”  As a result, they are one of the top grossing concert acts of all-time and they did it “acoustically,” i.e., without Technology, just Grassroots Word-of-Mouth.   Think about the influence and power of Patients utilizing the jet stream-like growth of HCSM to publicize Services like Google Health.  For the first time in many years, healthcare would then become an industry as hip as the Mobile Phone or Computer industries and that will attract top-notch employee talent and it will strongly incentivize  Physicians and Hospitals to enter into local Provider Agreements with the demographically appropriate Patients in the Google Health-type Service.  On the face of it, it appears that by just having Patients advocating a “Google Health” type quality Service within HCSM and having that Service follow The Grateful Dead business model we Patients will help bring about the changes in healthcare we have sought for so long.   Who else but Patients should be doing this anyway?

In terms of brief background on The Grateful Dead, while other bands saw touring and playing live concerts as an expensive and never-ending personal-demon filled global road trip experience that only served to market their latest albums/CDs, The Grateful Dead turned that business model on its head and instead built up their live concerts into their primary revenue-generating vehicle.  Therefore, their investment in encouraging fans to tape concerts and share them with one another created unique commodities such that if they played 300 different concerts in a given year then they had 300 Unique Products for that year. They also redefined “Community” as not just a “Place” but more as a destination where a fan could meet other fans and partake in experiences they both enjoyed and this included the purchasing of Grateful Dead Merchandise, another huge revenue-source. The “Suits” (i.e., the record company executives who always think they know best how to market an artist’s music) were concerned that encouraging the free swapping of live Grateful Dead concerts would cannibalize Grateful Dead album/cd sales but they completely missed what was really happening.  The Grateful Dead were sharing their music with the world in effect telling fans, “Check it out.  That is what we sound like when you come to see us play Live.  Stay in touch with us and when we come to your town, tell all your  friends, then come out and watch us play.  Better yet, come along for the ride and you can experience that sound in cites all over the world and you’ll be hanging out with people just like yourself who also enjoy how they feel when they listen to our music.”  A “Suit” can’t communicate all that in a Marketing Campaign.  Only a FAN CAN DO THAT, just like only a Patient can truly promote the benefits of a Service like Google Health.

Therein lies the rub, as they say, with Google Health, because the value of that Service to Patients is almost limitless and there are various Physician Practice and Hospital Provider Integrations possible within the demographically desirable Google Health EMR-like database (but, of course, only with the Patient’s prior consent).  Therefore, Google Health needs to get its Patient-Consumers to tout its Service so that it gets picked up by the powerful HCSM “winds of change” and becomes the norm for Patients whose most effective tool against the barrage of medical paperwork, appeals, prior authorizations, submission of claims, appeal of claims, etc. is Organization.  Unfortunately, in the most recent “Patient 1.0” version of Google Health they measured their progress and charted their course by the more traditional standards, and did not invest enough time and they undervalued the use of Patients as Testimonial Marketers.  At the same time, again by utilizing the “same old, same old,” they also overestimated the acceptance of, and participation in, the Service by medical practices as if that were some touchstone of success.  Remember, HCSM is a Patient-Driven Medium so catering to the Physician crowd instead of the Patient population is like going through the Oscar “Best Actress” eligibility rules with Kim Kardasian.  There is some cosmic rationale to that conversation, and she’s gorgeous so there’s that, but unless she marries a guy named “Oscar,” she will never utter that word when discussing business and her career.  (To Ms. Kardashian’s credit, she is a VERY bright business woman who also knows this and she knows exactly who her audience is and thus who she must cater to. Services like Google Health who tap into HCSM must do the same.   Physicians and Hospitals will follow in due time.)

It took the banking industry a long time to gain widespread internet acceptance such that busy people now pay their bills on line routinely.  So now with the internet being an integral part of everyday life and HCSM being an insulated Patient-Driven movement, all a Service like Google Health has to do is re-launch with the street smarts Coolidge and Salami learned from their foray into the city playgrounds playing hoops and start a Patient Grassroots campaign run through HCSM.  Once challenged by a formidable opponent as dominate as Google, the political and regulatory hassles of hiding the aforementioned gross inefficiencies in its healthcare insurance business will outweigh the financial gain guaranteed by operating as De Facto Oil Cartels and this will make these Oil Cartel-like Health Insurers blink.  That’s why we need a company the size of “Google” to get into this industry as the Government will never be a viable player due to the ever-present potential for political influence. Once HCSM exposes these gross inefficiencies through Patent Communities and Empowered Patients, which incidentally are as closely guarded by these Health Insurer/De Facto Oil Cartels as that of the acting talents of Kim Kardashian,  that’s when Hospitals and Physicians will get fully in the Game and THEN Services like Google Health will be the NORM and our Healthcare System will be truly Reformed.

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Posted in "Confessions of a Professional Hospital Patient", Google Health, Grateful Dead, Health Care Social Media, Health Insurers, Health Technology, Healthcare Reform, Medical Records, Patient Tools, Relocating with a Chronic Illness, The Empowered Patient

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Doctor-Patient Relationship – Communication, Collaboration, Mutual Respect & Trust

Posted on June 16, 2011 | 14 Comments

Due to Health Technology and the increased focus on Consumerism in Health-care, the Doctor-Patient Relationship is changing as fast as Congressman Anthony Weiner’s explanations about his Twitter transgressions.  All jokes aside, however, this is becoming a real problem for BOTH parties as Doctors try to service (and grow) their existing Patient Populations while simultaneously deal with increasingly challenging Health Insurance Company/Payor Productivity Payment Requirements and Patients literally don’t know what to do with their sudden “Patient Empowerment” which they keep hearing about from Dr. Sanjay Gupta on CNN.  As with anything else in Life, things ALWAYS come back to BASICS.  Thus, if you focus on Simplicity and treat others the way you would want to be treated, you can’t go wrong.  But how do we do that to fortify the Doctor-Patient Relationship in a 24/7, 365-day world of Health Care Social Media (“HCSM”) in which just one negative comment by a disgruntled Patient (or one with a basic personality conflict with the Doctor) can initiate an unfair world-wide Professional Reputation attack on a Medical Professional who was just trying to do his or her job?

As an almost 30 year sufferer of the Chronic, Incurable and Auto-Immune “Crohn’s Disease,” I have  had dealings with Doctors who have possessed a broad set of great, good and bad traits such as: gifted and compassionate; poorly skilled; poor communicator; excellent but with bad bedside manners (these are usually Radiologists by the way!); arrogant; strictly business (while being  closely examined – “Michael, your Surgical Wound looks like it is healing fine but did you know that you have an outstanding balance of $249,86?”); so myopic toward their own Specialty that if an ax were lodged into my forehead and they were a Pulmonologist they would give me the “all clear;” and bad listeners.  Given this continuing eye-opening experience, I have learned that the foundation of the Doctor-Patient Relationship rests on: Communication, Collaboration, Mutual Respect and Trust.

However, this foundation is a Two-Way Street as I find the most common problem with Doctors to be their refusal, reluctance or mere forgetfulness to use their most effective diagnostic tool, i.e., LISTENING.  Often times, their failure to Listen is driven by the extraordinary Diagnostic Testing Tools at their disposal such that it is now likely that a Test Result will tell them what they think they need to know, and thus they shun all Patient expertise no matter the Disease, Duration of Disease or constructive comment from the Patient.  Doctors should know better as Patients are PEOPLE and sometimes even the most technologically advanced diagnostic test will miss something so obvious or it will pick up on something completely irrelevant such that each miss or misdiagnosis could have been quickly dismissed by the Patient.

That said, Patients have an obligation to be succinct out of Respect for the Doctor’s Available Time when they do speak, elaborate or ask questions in an unsolicited manner during a consultation or examination with a Doctor since the Doctor is up against time constraints the Patient is unaware of and as a result the Patient is only allotted a certain amount of it and therefore it must be used wisely and for that Patient’s benefit.  But when the Patient “permits” the Doctor to do his or her job, this enhances the relationship for the next interaction – whenever that will be.  This “interplay” of sorts is where the Mutual Respect notion comes into play.  As the Joe Friday character from TV’s “Dragnet” would often say or infer, “Just the Facts, ma’am.”  Patients would be wise to be mindful of that same approach during the Doctor-Patient consultation/examination.

I also think Communication, Collaboration, Mutual Respect and Trust is most solidly built when both parties are conscious of establishing “consistency” because the Doctor-Patient Relationship requires a certain “familiarity” between the two (2) to afford enough time for each to best understand the other.  Over time, this comfort with one another breeds Trust and Credibility.  [This is why changing Doctors because of changes in Health Insurance Coverage is so difficult on Patients and I think almost discriminatory against chronically ill Patients like myself who count on a long-established relationships with particular Doctors in most efficiently treating Disease flare-ups.  It is also more cost-efficient but since the Health Insurance Companies operate their businesses like Oil Cartels, they don’t care about Efficiencies of any kind for if they did we would at least see Electronic Medical Records (“EMRs”) in place YEARS AGO.]

In summary, the Doctor-Patient Relationship is Fine; it just needs to get back to Basics.  Additionally, if “nurtured” properly, this professional relationship typically gets better over time.  If it does not, however, THEN it is time for the Patient to find a new Doctor.  Conversely, when the Doctor-Patient relationship stagnates and its lack of usefulness for the Patient is NOT apparent to the Patient (and that can easily happen  for a number of innocuous reasons), the Doctor should tell the Patient that he or she would be better served by another Doctor – especially in this new Global HCSM environment in which the possibility of an almost instantaneous unfair Reputation Attack is only a Tweet or  Click away.  BTW – that’s how a Doctor should handle unfair criticism that is posted in HCSM.  If it has malicious intent, call an Attorney but if it is simply a Patient venting, just stick to certain rules, be fair to all Patients, and treat your Patients as “People” AND in the manner YOU would want to be treated if they were the Doctor and you were the Patient.

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